Sally Roberts is Lead Nurse (Quality and Partnerships) at Walsall Clinical Commissioning Group. Here she describes work undertaken jointly by Walsall CCG and Walsall Healthcare NHS Trust, which has led to the implementation of a new integrated health care model within care homes.
Walsall’s new model of care has enabled the whole care home sector to raise standards, measurably improve outcomes for residents in care homes and reduce unnecessary hospital admissions.
Our work commenced in earnest with the nursing home sector over three years ago, at a time when there was increasing suspension of admissions, often due to poor quality and patient safety issues; these reduced market capacity and choice for people, and created financial uncertainty for some smaller independent homes. Care home managers reported in several forum meetings that they were struggling with poor staff retention, disrupting stability of care, leading to ineffective planning and viability of the home in the long term. In addition, the lack of proactive management of patients resulted in a high number of avoidable hospital admissions.
An analysis undertaken by Walsall CCG to explore the factors that resulted in unplanned admissions to the local hospital: it revealed that amongst Walsall Nursing Home patients admitted to hospital, 78% were admitted by West Midlands Ambulance Service from 999 calls made by nursing homes. Further analysis revealed that 89.8% of hospital admissions were attributed to diagnosis of chest infection, falls and urinary tract infection: all conditions which might have actually been treated in the care home, preventing hospital admissions. A significant number of residents were admitted into hospital for end of life care.
Since the audit, an enhanced model of health care has been designed with the care home sector and key partners to raise quality standards and transform the delivery of health care services to residents.
At the heart of this work is the understanding that care homes are a valued part of the overall spectrum of care and support services within our health and social care community.
The model aims to:
Provide case management in care homes. A dedicated case manager is allocated to the care homes. Their role is to increase the number of early intervention plans in place for predicted emergencies, reduce the number of inappropriate 999 West Midlands Ambulance calls, and reduce the number of residents being admitted into hospital unnecessarily.
Deliver monthly educational sessions to the care home staff on end of life care, management and treatment of urinary tract infections, chest infections, falls, constipation and treatment for hypoglycaemia.
Align nursing homes to a named GP practice. The GP, pharmacist, case manager and a nurse each visit the care home on a weekly basis to undertake proactive ward rounds. During the ward round residents receive a health assessment and medication review: where indicated, rapid holistic assessment and care planning for residents with sub-acute illness is undertaken by the rapid response team, and the patient is admitted to the virtual ward.
Early analysis of this work from January 2015 to June 2015 has demonstrated a 63% reduction in hospital admission rates from nursing homes in Walsall. A further blog discussing the role of the community matron, ambulance service, home manager and GP is planned: this will give some insights into how these roles are supporting homes to deliver the best care to Walsall patients, and what impact working together has made for delivering good quality care to this vulnerable cohort of patients.
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British Geriatrics Society 
Wow, some fantastic outcomes from teh approach – great work!
Oxfordshire has done something similar, but we have not had any effect on care home admissions. Those who are admitted mostly fall into one of two categories. Either they obviously need hospital – IV fluids, antibiotics, supplementary oxygen, need X rays or are bleeding – or they have been admitted from a residential home, where the carer (no medical training) has phoned 111 or out of hours and has been told to call an ambulance. We have reduced “last gasp” admissions – those who die within 72 hrs of admission by 50%.
By getting nurses and therapists from the Care Home Support Service to visit care homes, we have improved standards, and have provided information allowing the worst ones to be closed, and have intiated drug review, falls prevention and end of life planning. We are now using care homes as temporary placements for those waiting care homes or care packages, which has freed up over 80 acute beds.
Care homes are the future. That is where the nursed beds are. They will allow the NHS to cope with the demographic surge.